NUCLEATED ERYTHROCYTES AND INTRAVENTRICULAR HEMORRHAGE IN PRETERM NEONATES

Objectives. Increased circulating nucleated erythrocytes (NRBCs) in th e newborn period can be markers of chronic fetal hypoxia, which in tur n may be a risk factor for intracranial hemorrhage (IVH). To evaluate the relation between chronic intrauterine hypoxia and IVH, we compared the courses of the absolute NRBC (ANRBC) count in preterm newborns wi th and without intracranial hemorrhage. Methods. We measured ANRBC cou nts in the first 6 days of life in appropriate for gestational age new borns at 32 weeks' gestation or earlier with (n = 46) and without (n = 103) IVH, who were not at risk for altered erythropoiesis. Results. T he ANRBC counts at birth were higher in infants who developed severe I VH than in control infants without IVH (P < .03). The ANRBC counts pea ked on day 2 or 3 in newborns with IVH, but declined continuously from a peak on day 1 in the control group. Stepwise regression analysis of multiple variables revealed that the grade of IVH had the greatest im pact on ANRBC counts. An ANRBC count of at least 2.0 x 10(9)/L on day 1 of life had a sensitivity of 63% and a specificity of 79% in predict ing grade III or IV IVH. Conclusion. An elevated or increasing ANRBC c ount in a preterm newborn is a potential marker for an impending or pr esent severe IVH, respectively, and may reflect a state of altered pre natal or postnatal erythropoiesis.